More recently, 3 trials were done to evaluate glycoprotein IIb/IIIa antagonists as adjuncts to oral anti- platelet therapy in patients with primary PCI.54-56 The results bring into question whether glycoprotein IIb/IIIa antagonists provide additional benefit to STEMI patients who received dual antiplatelet therapy before catheterization. The ACC/AHA guidelines judge that routine use of glycoprotein IIb/IIIa antagonists for such patients cannot be recommended, although some patients (eg, those with a large thrombusburden or who received inadequate thienopyridine loading) may
as 30 minutes after administration.64 Prasugrel is superior to clopidogrel in preventing ischemic events in patients with acute coronary syndrome undergoing PCI, even though there is an associated greater risk of bleeding.24,35,57,65 Prasugrel therapy should be individualized and targeted toward those patients with stents or patients with decreased platelet inhibition by clopidogrel.57 Patients with a history of cerebrovascular events have experienced significant harm from administration of prasugrel.35 Prasugrel has a black box warning, not to be used in patients with previous stroke or transient ischemic attack because of its greater tendency to cause intensive inhibition of platelet aggregation in general and the findings of increasedlevels of bleeding compared with clopidogrel.66 Aspirin.Aspirin inhibits the cyclo-oxygenase enzyme, which stops prostaglandin synthesis and release, and inhibits prostaglandin synthetase action, which prevents formation of thromboxane A2, thus inhibiting platelet aggregation.39 Long-term aspirin therapy is recommended for patients who undergo any revascularization procedure, including PCI.
Hemostasis Methods Currently, 3 main techniques are used to achieve hemostasis at the femoral access site after PCI: manual compression, mechanical compression, and vascular closure devices. Manual Compression.Manual compression has been the “gold standard” for obtaining hemostasis at the vascular access site for years, but this standard has changed as new devices have come on the market.
benefit. Clinical practices with these and other antithrombotic agents continue to evolve.